PM&R Resident E-Newsletter

June 2015

A 3 Part Series – Journey to the East: A Physiatry Resident Goes to Japan & Other Musings on International Electives in PM&R Residency

Charles Odonkor, MD
Graduation Year: 2017
Johns Hopkins University

Part 2 – Time in Japan

First Night:

The breathtaking aquamarine coastline engulfed by rugged mountains and a landscape bedecked with green shrubbery marked my first aerial view of Japan. With an eye for the aesthetic, I devoured the sights and scenes as we descended on Honshu, sating my wanderlust and dromophilic sensibilities. On arrival at Narita after the 18-hour long flight from Dulles Airport, I skidded past a sea of friendly faces to catch a connecting flight to Nagoya. My gracious hosts from Fujita Health University (FHU) met me in the arrival lounge, and we stopped by a currency exchange booth, where I picked up a Japan Rail Pass, exchanged dollars for Yen, and rented an iPhone. I felt lucky to know some basic Japanese since everyone we met spoke mostly Japanese. People were, however, very polite and bowed when greeting; the depth and duration of the bow marked the degree of respect expressed. After a big feast of sushi/sashimi, we caught a ride in a pristine taxi to the FHU dormitory, where I stayed for the month.The dormitory hosted other international students, as well as Japanese medical students and residents.

Home-Style Sushi

I retired to bed late, fighting jetlag but grateful for a safe trip, and the exciting promise of a wonderful adventure in a new place

Work

Welcome Sign on the Rehab Floor

Commute to and from work was a quick 5-minute walk due to proximity of the dormitory to the hospital. Morning rounds typically started at 9 am, although the residents came earlier to check up on their patients. One of the highlights of the month was dysphagia rounds, which happened 3 times every week. Dysphagia rounds focused on patients with swallowing impairments in all units at the hospital. I observed rounds as part of a rather large transdisciplinary team, which consisted of: rehab (physiatrists, physical, occupational, speech and language therapists), dentistry (oromaxillofacial surgeons, dentists, and oral hygienists), internists (hospitalists), nutrition support (nutritionists, dietitian, nutrition tech) and nursing (certified dysphagia nurse).

After discussing all patients in the workroom, we would proceed to rounding on all the patients in the different units, starting from the rehab unit, then to intensive care, neurology and neurosurgery wards, respectively. This format was different from rounds in the states, where rounds only focused on the inpatient rehab unit. There were no private rooms on the wards; each room had about 4-6 patients, separated by curtains. As part of rounds, bedside video-endoscopy was performed by the physiatry and dentistry attendings, and sometimes by the residents. The speech therapists would also perform fluoroscopic studies in the radiological suite but under the guidance of the physiatrists. We saw a wide variety of cases including patients with bulbar palsy, laryngeal and esophageal cancer, Arnold-Chiari malformation, amyotropic lateral sclerosis, and Parkinson’s, among others. Since nutrition was of utmost importance, almost every patient suspected of dysphagia automatically received a nasogastric tube. Unlike in the United States, percutaneous gastrotomy tubes were rarely ever used in Japan. Given the major hospital-wide emphasis on dysphagia management led by the rehab department, FHU has the lowest rates of aspiration at 4% compared to the global rate of 10-12% of all hospitalized stroke patients.

Spotlight on the New York Society of Physical Medicine and Rehabilitation

In light of recent conversations, we want to feature more opportunities for residents to become active in their field of PM&R. This month, we have invited Dr. Xu, a resident leader in the New York Society of Physical Medicine and Rehabilitation, to discuss resident involvement in state societies. While not all states have one, state societies often have excellent opportunities in networking, leadership, advocacy, and other activities. For more information, you can check out some state society information on aapmr.org.

How does the New York Society of Physical Medicine and Rehabilitation serve physiatrists and PM&R residents in New York?
The New York Society of Physical Medicine and Rehabilitation (NYSPMR) is a non-profit organization dedicated to the advancement of our field by providing educational, networking, leadership, and legislative opportunities. The society connects individuals across all levels of experience with our membership ranging from medical students to practicing physiatrists. Through the monthly CME-accredited lecture series, accomplished speakers expose young physicians to important topics as well as guide experienced physicians on future directions. Members gather at networking events that immediately follow the lectures.

An interactive experience in a more intimate setting is offered through the workshop series. For example, NYSPM&R recognizes musculoskeletal ultrasound as a valuable tool and the need to teach physiatrists this exciting tool. At the ultrasound workshops, volunteer physicians lead trainees through lectures followed by structured practice modules. Also, to help residents prepare for boards, members can sign up for the mock oral boards. For those not yet ready for boards, they can always practice their PM&R knowledge “game-show style” at the annual Rehab Bowl.

NYSPMR is proud to help serve our community. Current outreach activities by NYSPMR members include volunteering for the Special Olympics among others. The society is also an advocacy platform through which members have the opportunity to affect change at the state level. Multiple times throughout the year, NYSPMR joins the lobbying efforts of the NYS Coalition of Specialty Care Physicians in Albany, NY.

What is your role in the organization and what does that involve?
My role as the clinical education coordinator involves working with the clinical education chair, Dr. Laurentiu Dinescu, pain management attending at Kingsbrook Jewish Medical Center, to implement the annual workshop series. The curriculum is decided upon by the entire NYSPMR board to cover fundamental clinical skills and emerging techniques. This year we have 12 sessions to cover prosthetics, spasticity, osteopathic manipulation, PRP injection, musculoskeletal ultrasound, and more. I invite speakers and instructors to participate in these events, many of whom have been with NYSPMR for years. As always, I appreciate the time that these individuals have volunteered on their weekend mornings to teach.

My goal is to ensure that the attendees have an enjoyable and interactive experience with new skills that they can immediately use. Beyond that, I hope that they walk away with the inspiration to pursue self-directed training.

How did you first become active in your state society?
I was fortunate enough to have been invited into this role by my friend and colleague Dr. Mikiko Murakami, an aspiring and soon-to-be pain management fellow at UCSD. I took an interest in the workshops when she had this role. She believed that I would do a good job filling in her shoes after she left, introduced me to Dr. Dinescu, and I am so glad she did!

What other resident opportunities exist in your state society?
There are many other board positions for residents and fellows to take on leadership roles. All of the events I mentioned are opportunities for residents to learn, teach, volunteer, and connect. Among one of the largest NYSPMR events of the year is the annual Job Fair which brings together many employers and fellowships in the region.

What recommendations do you have for residents that are interested in becoming involved in their state societies?
I think being involved in your state society is rewarding and a great way to network. Although not all states have state societies, I would expect most to be welcoming to nearby states. To become involved, showing genuine interest is key. Attend the events and introduce yourself to others. Be sure to express your interest early on. You never know when you might be talking to the friend of a board member who just happens to be looking for someone to fill an open position.

A note from Dr. Andrew Collins, RPC Secretary….
I hope that Dr. Xu’s information has inspired many of you to reach out to your state organizations to see what opportunities may be available to you. As an active member of the Academy’s Resident Physician Council Board, I encourage you to also become involved in your national organization. The rewards, networking, and knowledge sharing opportunities have been invaluable! To find a volunteer opportunity that matches you within the Academy, click here. To find specific resident opportunities, click here.

Academic Dues Renewal Available Soon

All resident members of the Academy are on the academic cycle (July 1–June 30). Dues renewal will open soon! Check theAcademy’s websitein early July to renew your dues online quickly and easily. Your residency program may provide a stipend for association membership dues, so be sure to check with your program coordinator for more information.

Don’t Forget!!! Private Resident Physician Council Forum

PhyzForum has been simplified! Visitwww.PhyzForum.org, sign in, and locate the Discussions tab. This members-only area provides a drop-down list of all forums, including an exclusive forum for the Resident Physician Council that can only be seen by AAPM&R resident members. Practicing physiatrists do not have access. The goal is to give residents an environment in which you can ask questions, share learnings, and engage with your peers.

All other forums are available for you to explore, but to start a discussion or reply to a thread, you must be enrolled! All you have to do is visit My Preferences in the upper, right-hand corner, locate the "Forums of Interest" box, and make your selections.

The new PhyzForum offers 2 ways to subscribe and receive email notifications of discussions—at the forum level and/or for a specific discussion. The forum-level subscription is available when you click “Participate in Discussions.” You can set the frequency of which you receive notifications—none, immediate, daily, or weekly. If you were already enrolled in a forum when first visiting the new site, your subscription has automatically been set for weekly notifications. For discussion-specific subscriptions, simply look for “Subscribe” underneath the posted discussion.

View the position descriptionsand stay tuned for more details.Next month, the Resident Physician Council (RPC) Nominating Committee will open the call for nominations for the RPC board positions of president, vice president, and secretary, as well as all committee and liaison positions. Any interested, current AAPM&R resident members (PGY1–3) may apply. This is your opportunity to gain invaluable leadership experience, insight into the specialty of PM&R, and to serve on behalf of the resident membership of AAPM&R, so don’t miss your chance to get involved!

PhyzForum Networking

The General and Medical Rehabilitation Council is hoping to increase resident involvement in online discussions through PhyzForum. Anonymous resident questions are currently being posted for members to respond to. Please feel free tolog inand view/participate in these discussions, or you may also submit questions through the Resident Physician Council by emailing rpcadmin@aapmr.org. All requests will be posted anonymously.

Check out the April Issue ofPM&R

In her first column asPM&R’s new Ethical-Legal Feature Editor, Dr. Debjani Mukherjee is focusing on residents. She asked 4 residents about ethical issues they have faced in their residencies. Check out what your peers at Spaulding, RIC, Johns Hopkins, and Nassau Medical Center had to say.

Plus, don’t miss the supplement on regenerative medicine, included in the April issue. This supplement,Physiatric Applications of Stem Cell Therapies in Regenerative Treatments of Musculoskeletal Conditions, features state of the art reviews. This supplement is also accompanied by an SAE-P. Visit themē®websitefor more information.

Are you following the Journal onTwitterandFacebook? Keep the conversation going and share your experiences with us!

2015 Annual Assembly Registration is Open!

Are you a PM&R resident looking for education and networking events tailored specifically for you? Don’t miss this year’s Annual Assembly in Boston, October 1-4! With approximately 500 residents attending each year, the AAPM&R Annual Assembly is the largest annual gathering of PM&R residents. Balancing the clinical with the practical, the Annual Assembly is an excellent opportunity for residents in PM&R programs to learn more about the specialty and AAPM&R.

Annual Assembly Workshop Volunteers Needed

If you are planning to attend the AAPM&R 2015 Annual Assembly in Boston this October 1-4, volunteer a bit of your time—and reap the rewards! Various workshops require the assistance of volunteers and AAPM&R welcomes and appreciates the help of its resident members. Residents who volunteer to assist with a workshop will be given complimentary access to that session, and eligible for remuneration ($100 per day for most). If you are interested in volunteering,please click here to access the 2015 Annual Assembly Workshop Volunteer Survey!

Strategic Coding & Reimbursement Workshops

Are you a 4th year resident? Graduation is right around the corner and now is the perfect time for you to prepare for practice management. From reducing claim rejections and improving accounts receivable management to decreasing the risk of an audit, appropriate coding and documentation are essential in practice. APM&R is working in conjunction with KarenZupko & Associates, Inc. to provide PM&R-specific coding and reimbursement workshops to deliver the information you need to select codes accurately, document them appropriately, and optimize revenue and cash flow.

AAPM&R is creating a valuable study resource for residents preparing for the American Board of Physical Medicine and Rehabilitation (ABPMR)Part I examination. It will feature over 800 questions covering the breadth of the exam and will provide immediate feedback with explanation. Keep an eye on themē®websiteas you prepare to study!

What's Coming Next

Want more resident-specific content before then?“Like” the Academy on Facebookto get additional articles written by your peers right in your news feed.Look for the next issue of thePM&R Residentin your email inbox in August.